Even Hippocrates believed in the importance of protecting ones health. It is much easier to protect against or prevent disease than it is to treat disease after it happens. Obesity is a prime example of this concept. Preventing overweight and obesity is easier than treating it.
ADA position statement – primary prevention is the most effective, affordable course of action for preventing and reducing risk for chronic disease. Nutrition and physical activity are key factors in health promotion.RD’s – educate, counsel, develop and facilitate programs, evaluate and research effectiveness of interventions, advocate for funding and policies that support health promotion, deliver cost-effective interventions to change health behaviors to reduce chronic diseaseHealth promotion takes place in the clinic and the community. Health – a state of complete physical, mental, and social well-being, not merely the absence of disease. Capable of remaining independent.
Determinants of health include genetics, lifestyle, living conditions, and environment. Environment and behaviors have been found to have a much bigger impact on health than biology. Nature vs. nurture debate.
Social – environment and communityOccupational -The occupational dimension recognizes personal satisfaction and enrichment in one's life through work.Spiritual - recognizes our search for meaning and purpose in human existence. Physical - recognizes the need for regular physical activity. Intellectual - recognizes one's creative, stimulating mental activities. Emotional - recognizes awareness and acceptance of one's feelings. Emotional wellness includes the degree to which one feels positive and enthusiastic about oneself and life.
Health promotion is not just about what you eat. Health promotion intends to change all health related behaviors:Eat healthierIncrease activityStop smokingGet more sleepBuild social networksBalance work with playGet a hobby & relaxHealth education uses behavior change theory to help identify motivators and strategies for helping people to change.
We have talked about the levels of prevention. And we often associate wellness and health promotion with primary prevention. However, health promotion must happen at all levels of prevention. Unfortunately much of the health promotion does not happen until the tertiary prevention level. Motivation for health changes as you go across the continuum for most people. When they are well and healthy they may be less motivated to have health promoting behaviors because there are no immediate consequences to the poor health behavior. Motivation tends to increase as one moves along the spectrum and disease develops and then it is more difficult to prevent further complications. Even when disease is present, motivation for self management is a significant challenge. Social Cognitive Theory uses the self-efficacy construct to explain why some individual are better at self management than others. In a nutshell, this comes down to the individual believing that they are capable of self management. This requires education, modeling, and practice of the new behavior. Self-efficacy is impacted by social and environmental determinants of health.
Within our current system of health care, prevention is up to you, the individual. We take a down stream approach in which care is typically not received until you have gone over the cliff. A disproportionate number of health care dollars are spent on tertiary prevention or medical care. Only about 5% of health care dollars are dedicated to preventive care. Our system is aimed at crisis care. You become sick, the doctor will fix it. This works great for things like infectious disease but not so well for chronic disease. The public expects a cure and is now disenfranchised with the medical system that can not cure whatever ails them.
20th century advances: vaccination, work safety, vehicle safety, control of infectious disease, decline in CVD death rates, safer & healthier food supply, healthier mothers & babies. And great strides were made in lowering CVD rates in the last 20 years of the 20th century due to new drugs and decreases smoking. However we find ourselves with an obesity problem that is driving the type 2 diabetes epidemic. VaccinationsControl of infectious diseaseSafer working environmentsDecline in deaths from CVDSafer & healthier food supplyHealthier mothers & babiesFluoridated waterRecognition of tobacco as a health hazard
As you can see here we have missed the target on several objectives related to nutrition and overweight. We madesome progress on calcium but not anywhere near the target goal.
As you can see here, the number of people at a healthy weight actually decreased from baseline, indicating the situation is worse than before. And the percent of obese individuals is double the desired goal and at least 10 percentage points above baseline.
Finalizing the goals and objectives of Healthy People 2020 is still in progress. But here are the proposed goals. They have expanded from 2 goals to 4. They are pretty lofty.
One thing that is different with HP 2020 is the idea of how the environment impacts health behavior and health outcomes. And this model has been developed to incorporate determinants of health that include not only individual health education but also the importance of policies and programs at the social, economic, cultural, living and working conditions levels. If education alone worked, we would not have as big of a problem.
Prevention interventions are very powerful and can happen at all levels of health care.
Quitting smoking dramatically effects risk of heart disease and cancer. Smoking prevention and quitting campaigns significantly impact health care costs. Just a 5-7% weight loss decreases risk of type 2 diabetes as well as lowers blood pressure, total cholesterol and overall CVD risk.
The workplace is a prime community environment for disease prevention. Most adults spend the most amount their time at work. And most chronic disease develops during the adult working years. Employers can have a significant impact on health but have lacked incentives to address health promotion. However, employers are now faced with sky rocketing insurance premiums, legislative requirements to provide health insurance, and are realizing the importance of keeping employees healthy. The reality that healthy employees are less costly employees is starting to set in.
Health promotion may take different forms from simply increasing awareness about a health problem to restructuring environments and city planning such as mixed use neighborhoods. Komen Race for the cure is probably one of the largest and most successful health promotion awareness campaigns on the planet. Mixed use neighborhoods would be places such as the uptown area in which housing, retail, grocery, restaurant, and parks are all in the same area and within walking distance. There is promising research that says people who live in these areas are more physically active. Don’t know if that translates into better health overall or better eating habits. But we do know that people who live in major cities and rely on public transportation have more normal body weights.
What motivates companies to implement health promotion and wellness programs? Bottom line and/or return on investment. How much money will they save by implementing a program. What motivates employees to participate?Need to use these motivators in your marketing efforts to convince the company you are worth hiring as a consultant and convince employees to participate. If employees do not participate, the company will not see a return on their investment.
A company may lack financial resources to support a program. Location, space and scheduling are other major issues. If employees do not participate the company is wasting their time and money.
Unit 2 wellness concepts programs & practices
Lona Sandon, MEd, RD, LD
The function of protecting and developing health must rank even above that of restoring it when it is impaired. —Hippocrates
Define the terms wellness and health promotion. Restate reasons for implementing wellness and health promotion program. Explain how wellness and health promotion programs improve health and reduce health care costs. Review examples of health promotion and wellness initiatives. Discuss best practices in wellness programming.
The effects of health care costs on U.S. businesses http://www.cdc.gov/leanworks/index.html
What do you think a dietitian who works in wellness/health promotion does? What does health mean to you?
Working/living/ social Community BackgroundBiology Lifestyle conditions conditions conditionsSex, race, Physical Housing, Climate, Nutritionage, activity, diet, education, geography, water policy,hereditary hobbies, occupation, supply, availability minimumfactors leisure time, income, of hospitals, wage, cultural use of any employment clinics, medical beliefs, values, type of drugs, status, social services, social & attitudes, safety networks, services, advertising, practices, socioeconomic industries, media medical self- status, government messages, care, stress race/ethnic structure, grocery food management health stores, recreation, distribution disparities transportation systems Table 1-1, Boyle & Holben, 2010
A. Wellness A ___ Includes positive emotions, relationships, ph ysical & mental traits, engagement, &B. Health Promotion satisfaction B ___ Intends to reduce or control risk factors for disease by empowering people to take control of their health
“Wellness is an active process through which people become aware of, and make choices toward, a more successful existence.” - National Wellness Institute (NWI) http://www.nationalwellness.org/index.php?id_tier=2&id_c=26
Developed by Dr. Bill Hettler, NWI Physical Spiritual http://www.nationalwellness.org/index.php?id_tier=2&id_c=25
Health Promotion – process of enabling people to increase control over, and to improve their health Typically focused on reducing, eliminating or controlling health risk factors
Dynamic balance of: physical, emotional, soc ial, spiritual, & intellectual health O’Donnell MP. Definition of health promotion 2.0: embracing passion, enhancingmotivation, recognizing dynamic balance, and creating opportunities. Am J Health Promot. 2009 Sept-
Motivates & supports lifestyle toward optimal health using health education & behavior change theory Am J Health Promot. 2009 Sept-Oct;24(1):iv.
Physical Fitness. Nutrition. Medical self-care. Control of substance abuse.Emotional Care for emotional crisis. Stress ManagementSocial Communities. Families. FriendsIntellectual Educational. Achievement. Career developmentSpiritual Love. Hope. Charity. http://www.healthpromotionjournal.com/
Individual is responsible for their own prevention Downstream health care system Majority $ are spent on curative care Designed to respond to crisis intervention Are people’s expectations of a cure to high?
Advances in the 20th century = people living longer with chronic disease Progress is now trending in the wrong direction Health disparities due to race, income, geography are significant Rising obesity in youths
Self-induced chronic disease Struggling public health infrastructure Rising cost of health care/insurance Concern with access to care
Nutrition & lifestyle related 1 Heart disease - $318 B 2 Some cancers - $89 B 3 Stroke 5 Diabetes - $116 B 9 Kidney disease Key risk factors: obesity ($61 B), physical inactivity, smoking, poor diet CDC http://www.cdc.gov/chronicdisease/overview/index.htm
7 out of 10 deaths due to chronic disease 133 million have at least 1 chronic disease Arthritis most common cause of disability Diabetes leading cause of kidney failure, amputations, & blindness > 1/3 adults do not exercise regularly CDC http://www.cdc.gov/chronicdisease/overview/index.htm
< 25% eat enough fruit/veggies 1 in 5 smoke Avg. medical costs $7000/person/yr (2006 estimate) 75% of health care $ spent on chronic disease CDC http://www.cdc.gov/chronicdisease/overview/index.htm
Nations health improvement agenda Vision, mission, & goals http://www.healthypeople.gov/2020/about/d efault.aspx Align goals/objectives with nutrition program planning Fell short of meeting 2010 goals http://www.healthypeople.gov/2020/default.aspx
HP 2010 obj.: 60% healthy HP 2010 obj: 15% obesity weight 35 60 30 Percent o f PopulationPercent of Population 50 25 40 20 30 15 20 10 10 5 0 0 Baseline Current 2010 Baseline Curent 2010 1988-94 estimate objective 1988-94 estimate Objective (healthy (obesity) weight)
1. Eliminate preventable disease, disability, injury, & premature death2. Achieve health equity, eliminate disparities, & improve health in all groups3. Create social & physical environments that promote good health for all4. Promote healthy development & healthy behaviors across every stage of life
A. Primary Prevention C ____ treatment to prevent furtherB. Secondary complications Prevention A ____ awareness &C. Tertiary Prevention environmental/policy influence on health B ____ screening & reducing risk
Showing a group of teenagers how to eat healthier using the MyPlate web site is what level of prevention?A. PrimaryB. SecondaryC. Tertiary
3 elements Health promotion (10) Early detection (20) Management of existing disease (30)
Quitting smoking ’s CVD risk by ½ in 1 yr. & ’s death from lung cancer risk by ½ in 10 yr. 5-7% in weight can prevent or delay type 2 diabetes in BP & total Chol ’s CVD risk
Adults spend most Healthier workers = their time at work Improved productivity Most chronic illness Less absenteeism develops during the Lower health care costs working years, 20-40 Improved morale & yrs. loyalty Employers can control the environment & policies that promote health
Enhance awareness Increase motivation Build skills Create opportunities & environments that make positive health practices the easiest choice O’Donnell MP. Definition of health promotion 2.0: embracing passion, enhancingmotivation, recognizing dynamic balance, and creating opportunities. Am J Health Promot. 2009 Sept-
Health screenings/HRA’s Poster boards* Smoking cessation Health Newsletters* Health fairs* Healthy cooking Brown-bag seminars* demos/taste tests* Weight loss programs* Stress reduction Fitness programs programs Nutrition assessments* Individual counseling* Injury prevention Vending/cafeteria policies* * Expertise of RD important
Concerns for one’s health Monetary incentives Free to participate During work hours Social interaction Reduced insurance premiums Health provider recommended Competition Leadership support
Lack of time Cost Competing interests/programs Kids got soccer practice Lack of interest Lack of support from friends, family, co- workers, leadership
Leadership buy-in Lunch-n-learns Identify a leader Wellness library Determine interest & Quarterly wellness assess needs newsletter Health Health policies screenings/HRA’s Leverage community Physical activity resources incentive campaigns Hunnicutt, D. Big steps for small businesses. Absolute Advantage, 7(3);2-48, 2008. Wellness Council of America www.welcoa.org
Leading Employees to Activity & Nutrition View Dr. William Dietz video http://www.cdc.gov/leanworks/why/index.ht mlWorkplace obesity prevention initiativeCase studies: http://www.cdc.gov/leanworks/why/casestudi es.html
Obesity – Impacts productivity Increases employer health care costs Increases absenteeism Strong association with chronic disease
Coronary Health Improvement Project ” affordable, lifestyle enrichment program designed to reduce disease risk factors through the adoption of better health habits and appropriate lifestyle modifications” http://www.chiphealth.com/index.php
Goals are to lower: blood cholesterol, triglycerides, blood sugar levels, & high blood pressure by reducing excess weight, enhancing daily exercise, & improving dietary choices And to eliminate smoking
Components Health risk assessment Lifestyle Education program ▪ four times a week for four weeks, or ▪ three times a week for five weeks, or ▪ twice a week for eight weeks Train the trainer approach ▪ Implements video lessons http://www.chiphealth.com/about_chip/course_content.php
Mission Statement http://www.washoe.k12.nv.us/staff/wellness- program/about-contact Framework – HP 2010 goals & Healthier US initiatives Create environments that: Increase awareness Promote positive lifestyles Lower disease risk Improve quality of life
Incentive driven: $40 per mos. Good Health Incentive Contribution paid by all employees Price is lowered potentially to $0 if: ▪ Employees participate in screening - $30 ▪ No health problems found - $0 ▪ Found at risk & participate in education programs 91-93% participation rates!!! http://www.washoecountyschools.org/staff/wellness-program
Variety of activities Picture gallery http://www.washoecountyschools.org/staff/wellness-program
Wellness at Work Toolkithttps://dwp1.dhs.oregon.gov/WellnessAtWork/
Harness collective power of Communities Health care professionals Volunteer groups Government agencies Academic institutions http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf
Well-being – help people take charge of their health School education Workplace wellness Faith-based communities Community based lifestyle interventions http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf
Policy promotion Environmental changes that support healthy living – mixed use communities Public transportation Fresh fruit & veggie access in all neighborhoods Phys ed requirements in schoolshttp://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf
Health equity Target social determinants of health ▪ Race, ethnicity, income, edu cation Equitable access to health screenings Coverage for prevention Access to healthy food
Research translation Communicate effectively what we know works Design and test effective strategies Spread the word quickly
Workforce development State funded chronic disease prevention program workforce Community prevention & self-management programs Worksite wellness program
Assess, develop, impl ement, Needs Assess manage programs ment Evaluate Evalua Plan effectiveness tion Act as Health & Wellness coach Monito Imple r ment
Wellness & health promotion aim to improve quality of life & reduce disease risk Health is more than just biology and individual choices Wellness programs lower health care costs RD’s do more than tell people what to eat – program planning & implementation